Dental appliance features for speech enhancement

ABSTRACT

Provided herein are orthodontic devices and methods for patients whose orthodontic devices are causing a lisp. The device can comprise an aligner configured to fit over a patient&#39;s dental arch and comprising an occlusal surface section positioned over an occlusal surface of the patient&#39;s teeth. The aligner can comprise a barrier portion extending laterally and adjacent to a region of the dental arch, the barrier portion allowing the patient&#39;s tongue to form a seal against the barrier portion when the patient is speaking while wearing the device.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationNo. 62/429,548, titled “ALIGNER FEATURES FOR SPEECH ENHANCEMENT,” filedon Dec. 2, 2016, and herein incorporated by reference in its entirety.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare incorporated herein by reference in their entirety to the sameextent as if each individual publication or patent application wasspecifically and individually indicated to be incorporated by reference.

BACKGROUND

Current clear orthodontic aligners can open a patient's bite temporarilydue to the thickness of the plastic trays. Because of the increasedvertical dimension from the bite opening, the patient's tongue may notable to create an adequate anterior seal when certain sounds are spoken.A preferred vertical overlap of the anterior teeth is 2 to 4 mm, withless than 2 mm but greater than 0 mm being minimally acceptable. Inparticular, when the vertical overlap of the anterior teeth opens suchthat the tongue is unable to form a complete seal, the sibilants may bemisarticulated, in some cases leading to lisping (or sigmatism).Inadequate vertical overlap of the posterior teeth (lateral open bite)can also contribute to a similar phenomenon stemming from the leakage ofair due to an incomplete seal formed with the tongue. The inability toproduce sibilant sounds properly during speech can be problematic forpatients during work meetings, speaking over the phone, personalconversations, etc. As a result of this effect on speech, aligner wearcompliance by the patient may be compromised, because the patients maysimply leave out the aligners during work or during interactions withothers in order to avoid lisping. If the amount of increased biteopening is relatively small, the tongue may adapt quickly over thecourse of a few weeks in order to create a better seal; however,compliance with aligner wear may be suboptimal until this time.

Some patients may naturally have a problem forming a seal between thetongue and the teeth even without a dental appliance in place, becauseof the presence of an anterior open bite, a lateral open bite, or both.The ability to reduce the open bite may improve the patient's speech,even if the open bite reduction is only temporary (i.e., while a dentaldevice specifically designed for this purpose is being worn).

Described herein are orthodontic apparatuses (e.g., devices, appliances,etc.), including aligners and aligner features that may address theseproblems.

SUMMARY OF THE DISCLOSURE

The present application relates to an orthodontic device that mayprevent, reduce, or inhibit poor speech articulation due to theinability to form an adequate seal between the tongue and the innersurfaces of a patient's teeth, which may result in lisping.

The devices may generally include an occlusal portion having adentition-receiving cavity extending laterally in an arch and having afirst vertical height, wherein the dentition-receiving cavity isconfigured to fit over a dental arch of a patient, thedentition-receiving cavity comprising an occlusal surface sectionadapted to be positioned over an occlusal surface of the patient'steeth. The device comprises a barrier portion extending laterally andadjacent to a region of the occlusal portion (e.g., a front region, alateral region, etc.), the barrier portion having a second verticalheight that is approximately the same height or a greater height thanthe first vertical height, wherein the barrier portion is laterallycontinuous to reduce or prevent air leakage therethrough, so that apatient's tongue may form a seal against the barrier portion when thepatient is speaking while wearing the device.

In another aspect, the application relates to an orthodontic alignerdevice that prevents lisping. The device comprises an occlusal portionhaving a dentition-receiving cavity extending laterally in an arch andhaving a first vertical height, wherein the dentition-receiving cavityis configured to fit over a dental arch of a patient, the occlusalportion further configured to apply a force to a first set of teeth inthe dentition-receiving cavity, the dentition-receiving cavitycomprising an occlusal surface section adapted to be positioned over anocclusal surface of the patient's teeth; and a barrier portion extendinglaterally and adjacent to the occlusal portion, the barrier portionhaving a second vertical height that is greater than the first verticalheight, wherein the barrier portion is laterally continuous to reduce orprevent air leakage therethrough, so that a patient's tongue may form aseal against the barrier portion when the patient is speaking whilewearing the device.

In some embodiments, the barrier portion is positioned on a lingual sideof the front region of the occlusal portion. The barrier portion cancomprise a ridge. In some embodiments, the second vertical height of thebarrier portion is more than about 0.5 mm higher than the first verticalheight of the occlusal portion (e.g., greater than .8 mm, greater than 1mm, between 1-6 mm, between 1-5 mm, between 1-4 mm, between 2-6 mm,between 2-5 mm, between 2-4 mm, etc.). In some embodiments, the secondvertical height of the barrier portion is more than about 1 mm higherthan the first vertical height of the occlusal portion. In someembodiments, the barrier portion is positioned on a buccal side of thefront region of the occlusal portion. In some embodiments, thedentition-receiving cavity is configured to fit over an upper dentalarch of the patient. In some embodiments, the dentition-receiving cavityis configured to fit over a lower dental arch of the patient. In someembodiments, the barrier portion is formed integrally with the occlusalportion. In some embodiments, the barrier portion is formed separatelyfrom and is attached to the occlusal portion. In some embodiments, thebarrier portion is positioned lingual to the occlusal portion adjacentto a portion of the barrier portion that fits over a patient's incisorswhen the device is worn by the patient. In some embodiments, the barrierportion is positioned adjacent to a portion of the barrier portion thatfits over a patient's incisors and canines when the device is worn bythe patient. In some embodiments, the barrier extends posteriorly tocreate positive vertical overlap in the canine, bicuspid, and/or molarregion. In some embodiments, the barrier is unilateral or asymmetric. Insome embodiments, the barrier portion is curved and/or tapered. In someembodiments, the barrier portion is connected to or used in conjunctionwith bite ramp features used for temporary bite opening.

In another aspect, an orthodontic aligner device that prevents lispingis provided. The device comprises an aligner body having adentition-receiving cavity extending laterally in an arch and having afirst vertical height, wherein the dentition-receiving cavity isconfigured to fit over at least a portion of a dental arch of a patient,the aligner body further configured to apply a force to a first set ofteeth in the dentition-receiving cavity, the dentition-receiving cavitycomprising a plurality of upper surface sections configured to bepositioned over occlusal surfaces of the patient's teeth when the deviceis worn over the dental arch of the patient, and a plurality of lateralwall surfaces configured to be placed in contact with sides of thepatient's teeth when the device is worn over the dental arch, furthercomprising a first occlusal cut-out region at a first terminal end ofthe arch and a second occlusal cut-out region at a second terminal endof the arch, wherein the first cut-out region and the second cut-outregions are surrounded by lateral wall surfaces, with the occlusalsurfaces of the patient's molars (and possibly also the premolars)exposed and able to touch the opposing arch when the device is worn overthe teeth. This design may minimize the temporary anterior bite openingthat can occur when orthodontic aligner appliances that cover theposterior teeth are being worn.

In some embodiments, the cut-out region extends over two or more teethwhen the device is worn over the patient's dental arch. In someembodiments, the cut-out region extends over three or more teeth whenthe device is worn over the patient's dental arch. In some embodiments,a thickness of the occlusal surface of the device is thinner near thefirst and second terminal ends of the arch, and gets thicker towards amiddle region between the first and second terminal ends of the arch.This middle region of the arch generally corresponds to the anteriorteeth. In some embodiments, the cut-out regions extend into the lateralwall surfaces of the portion of the dentition-receiving cavity adjacentto the patient's molars when the device is worn over the dental arch. Insome embodiments, the device comprises a barrier portion extendinglaterally adjacent to an anterior region of the aligner body, thebarrier portion having a barrier vertical height that is greater than afirst vertical height of the aligner body, wherein the barrier portionis laterally continuous to reduce or prevent air leakage therethrough,so that a patient's tongue may form a seal against the barrier portionwhen the patient is speaking while wearing the device.

In another aspect, a method of orthodontic treatment of a patient thatprevents lisping is provided. The method comprises positioning anocclusal portion of an orthodontic device over the patient's dental archso that the patient's teeth are contained within a dentition-receivingcavity of the occlusal portion, wherein, while the patient is wearingthe orthodontic device, a barrier portion of the orthodontic device ispositioned adjacent to a region of the occlusal portion and extendsvertically beyond the occlusal portion and away from the patient'steeth, in order to provide a sealing surface for the patient's tongueduring speaking.

In another aspect, another method to prevent lisping during orthodontictreatment of a patient is provided. The method comprises positioning anocclusal portion of an orthodontic device over the patient's dental archso that the patient's teeth are contained within a dentition-receivingcavity of the occlusal portion which applies force to the patient'steeth to align the teeth by gradually moving the patient's teethrelative to each other when the orthodontic device is worn, wherein,while the patient is wearing the orthodontic device, a barrier portionof the orthodontic device that is positioned adjacent to a region (e.g.,a front and/or lateral region) of the occlusal portion and extendingvertically beyond the occlusal portion and away from the patient's teethprovides a sealing surface for the patient's tongue during speaking.

In some embodiments, the barrier portion extends laterally adjacent tothe patient's incisors when the patient is wearing the orthodonticdevice. In some embodiments, the barrier portion extends in a continuouslateral surface adjacent to the patient's incisors when the patient iswearing the orthodontic device to reduce or prevent air leakagetherethrough. In some embodiments, the method comprises differentiallyapplying force to the patient's teeth to gradually move the patient'steeth relative to each other when the orthodontic device is worn. Insome embodiments, the method comprises positioning a second occlusalportion of a second orthodontic device over a second dental arch of thepatient so that the patient's teeth in the second dental arch are withina second dentition-receiving cavity of the second occlusal portion. Insome embodiments, the method comprises positioning a second occlusalportion of a second orthodontic device over a second dental arch of thepatient so that the patient's teeth in the second dental arch are withina second dentition-receiving cavity of the second occlusal portion andproviding a second barrier portion of the second orthodontic device thatis positioned adjacent to a second region of the second occlusal portionto provide a second sealing surface for the patient's tongue duringspeaking. In some embodiments, the lower jaw of the patient is able toreposition forward such that lower anterior teeth (with or without anorthodontic appliance) abut against a barrier portion located in theupper arch aligner in order to provide a sealing surface for thepatient's tongue during speaking. In some embodiments, the lower jaw ofthe patient is able to rest against a vertical stop feature in thealigner such as a bite ramp feature, with a barrier portion located inthe upper arch aligner built in to provide a sealing surface for thepatient's tongue during speaking.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe claims that follow. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 illustrates a temporary bite opening effect by the use ofaligners. There is a point of contact is in the terminal regions of thearches due to the occlusal thickness of the aligners.

FIGS. 2A and 2B illustrate an embodiment of an aligner having occlusalwindows in the terminal regions of the arch. The portions covering themolars have been removed.

FIGS. 3A and 3B illustrate additional embodiments of aligners havingocclusal windows. Portions of the aligner (on the occlusal surfaces)over both the molars and the premolars have been removed. Some occlusalregions in between the teeth have not been removed in order to providecrossbeam-like structural supports between the buccal and lingual wallsof the plastic appliance (interproximal cross supports).

FIGS. 4A-4D illustrate embodiments of a device having a barrier portion.

FIG. 5 illustrates an example of a tongue crib appliance 501 which istypically used to prevent the tongue from pushing the anterior teethforward.

FIG. 6 schematically illustrates an embodiment of an upper alignerhaving a barrier feature.

FIG. 7 illustrates embodiments of upper and lower aligners, the upperaligner having a barrier portion. The lower aligner may come into closeproximity of the upper aligner in the patient's existing biterelationship, or after the patient repositions the lower jaw forward.This configuration may be useful if a patient has an excessive overjetwhich leads to a large anterior opening.

FIG. 8 illustrates embodiments of upper and lower aligners, the loweraligner having a barrier portion. This configuration may be useful if apatient has an excessive overjet which leads to a large anterioropening.

FIG. 9 illustrates embodiments of upper and lower aligners both havingbarrier portions. The barrier positions may come into close proximity inthe patient's existing bite relationship, or after the patientrepositions the lower jaw forward. This configuration may be necessaryif a patient has an excessive overjet which leads to a large anterioropening, and/or if a patient has an anterior open bite which cannot besealed by only one barrier alone.

FIG. 10 illustrates embodiments of upper and lower aligners havingbarrier portions. This configuration may be useful if a patient has anegative overjet which leads to a large anterior opening.

FIG. 11 illustrates embodiments of an upper and lower aligner, the upperaligner having a barrier portion. This configuration may be useful if apatient has an excessive overjet which leads to a large anterioropening, particularly if the patient is unable to sufficiently advancethe lower jaw forward to create an adequate anterior seal with thetongue.

FIGS. 12A and 12B illustrates embodiments of upper and lower alignerswith jaw repositioning features in the upper and lower arches and alsohaving a barrier portion in the upper aligner (FIG. 12A) or in both theupper and lower aligners (FIG. 12B).

FIG. 12C is another example of a pair of upper and lower jaw appliancesincluding bite ramps and a barrier portion to enhance speech and/orpatient comfort. In FIG. 12C the barrier portion extends laterally alongthe lingual side of the upper aligner, adjacent to and on either side ofthe bite ramp(s).

FIGS. 12D and 12E illustrate front perspective and top bottom views,respectively, of the upper jaw appliance (which may be configured as analigner). In FIG. 12D, the bite ramps (e.g., bit supporting structures)are integrated into the occlusal surface of the apparatus and a barrierregion extends adjacent to the majority of the lingual side of theappliance to prevent air from escaping. The barrier region may have aheight that is approximately the same or larger than the maximum heightof the bite ramp(s). The dental appliance on the opposite side may beconfigured or otherwise adapted to allow the barrier region to seal anyair leak between and/or over the occlusal surface(s) of the apparatuses.In FIG. 12E, the top view shows the barrier region is configured as asingle barrier region extending from one side of the arch (adjacent tothe rear molars) to the opposite side of the arch.

FIGS. 13A-13C illustrates embodiments of aligners having anterior biteramps. FIG. 13A shows an aligner with a tapered barrier portion in theupper aligner to provide a seal against lateral anterior air leakagewhen the upper bite ramps are engaged by the lower anterior dentition,especially when a deep Curve of Spee is present. FIG. 13C has ananterior barrier portion in the upper aligner to provide an anteriorseal when anterior lingual bite ramps are engaged by the lowerdentition.

FIG. 14 illustrates an embodiment of a method of orthodontic treatment.

FIG. 15 illustrates another embodiment of a method of orthodontictreatment.

FIG. 16 illustrates a method for determining dimensions of a barrierportion of an orthodontic device as described herein.

FIGS. 17A and 17B illustrate an upper aligners having a barrier portionsimilar to that shown in FIG. 7, in which the lower jaw (which may ormay not have an aligner) may slide forward to a forward-repositionedlocation (shown in FIG. 17B) whereby a reduced anterior gap is createdbetween the upper barrier and the lower teeth.

FIG. 18 illustrates another example of an orthodontic applianceincluding a barrier portion to enhance speech and/or patient comfort. InFIG. 18, the apparatus includes an upper and a lower orthodonticappliance; the barrier portion is on the upper appliance, however it maybe positioned on the lower appliance. The upper and lower appliances inthis example each include a pair of wings (“precision wings”) thatlaterally interact with each other to engage with each other toreposition the patient's mandible (e.g., as part of a mandibularrepositioning apparatus).

FIGS. 19A-19B illustrates an example of another orthodontic appliancethat may be configured to include (as shown in FIG. 19B) a barrierportion to enhance speech and/or patient comfort. In FIG. 19A, theapparatus is one in a series of sequential palatal expanders that may besecured to the patient's upper arch through the dentition-receivingcavity formed on either side of the device; the dentition-receivingcavity includes a left dentition-receiving cavity portion and a rightdentition-receiving cavity portion that are connected by a palatalregion that is configured to be positioned adjacent to the patient'spalate. Each device in the series of sequential expanders compresses inthe transverse dimension enough during activation to engage the inner(lingual) surfaces of the posterior teeth, thereby transferring anyexpansion forces in the appliance through the posterior teeth to thepalatal bone structures. In FIG. 19B, the apparatus of FIG. 19A isconfigured to include a front-facing (anterior) barrier region that mayprevent lisping. The barrier region may be connected to an extensionthat extends from the palatal region.

DETAILED DESCRIPTION

Described herein are apparatuses including orthodontic devices that mayprevent, reduce or inhibit sigmatism, or poor speech articulation ofsibilants due to the inability of a patient's tongue to form a completeseal with the back of their teeth which results in lisping. Although theapparatuses and methods described herein are generally directed towardsdental appliances, e.g., including, but not limited to aligners fortreating teeth misalignment; any of these apparatuses and methods may beused for any other dental or orthodontic device, to improve speech whenwearing such devices; furthermore, any of these apparatuses and methodsmay be used exclusively to treat existing patient miss-articulation(i.e., lisping). For example, these apparatuses may be configured asspeech therapy devices. Examples of other appliances that may beconfigured or adapted to prevent speech problems and/or enhance comfortas described herein may include palatal expanders, mandibularadvancement apparatuses, and the like. Any of the features shown hereinfor any specific appliance (e.g., aligners) may be used as par to anyother dental appliance.

For example, disclosed herein are apparatuses and methods for addressingspeech alterations caused by orthodontic appliances. FIG. 1 illustratesan example of an upper aligner 102 and a lower aligner 102′. An aligner,such as the shell type aligners shown in FIG. 1, can temporarily openthe bite due to the thickness of the aligner on the occlusal surface ofthe teeth. In FIG. 1, a posterior contact 108 leads to an anterioropening 110. The opening 110 (which may be smaller than that illustratedin this example) can prevent the patient's tongue 104 from creating anadequate anterior seal when certain sounds are spoken, causingmisarticulations. If patients are less likely to talk during the day orare less concerned about being embarrassed when speaking while wearingaligners, they are more likely to be compliant and wear the devicesduring their everyday social activities regardless of whether they lisp.If however, they need to talk without lisping or are embarrassed becausethey are lisping with the aligners in place, they are more likely toleave the aligners out during the day and only wear them when they arenot interacting with others. This inconsistent usage may result insuboptimal orthodontic treatment results. Similar issues may occur witha single aligner or with other orthodontic appliances.

One way to address this problem is to reduce the thickness in thealigner which is increasing the vertical dimension and causing the biteto open. For example, thinning or removing portions of the aligner inthe areas covering the posterior teeth (by creating occlusal windows,for example) can allow the back teeth to come closer together (or touch)in order to let the front portions come closer together, therebyreducing the impact of increasing the vertical dimension. For patientswith a high a mandibular plane angle, any increase in the verticaldimension of the posterior teeth results in a magnified increase in theanterior vertical dimension. In other words, the change in the anterioris not necessarily 1:1 with the vertical change in the posterior, andmay be a multiple instead (e.g., 2× or 3×).

FIGS. 2A and 2B illustrate an embodiment of a device having occlusalwindows. FIG. 2A illustrates a perspective view of an aligner 200comprising an aligner body 202. As shown in the bottom view of FIG. 2B,the aligner body 202 has a dentition-receiving cavity 204 extendinglaterally in an arch, as shown by arrow 206 and having a first verticalheight, h. The dentition-receiving cavity 204 is configured to fit overat least a portion of the dental arch. The aligner body 202 may beconfigured to apply a force to a first set of teeth in thedentition-receiving cavity 204. The dentition-receiving cavity 204comprises a plurality of upper surface sections 208 configured to bepositioned over the occlusal surfaces of the patient's teeth when thedevice is worn over the dental arch of the patient. These sections maydivide the body region 202 into a plurality of (in this example,laterally contiguous) chambers each substantially conforming toindividual teeth. In some variations the dentition-receiving cavity maybe separate sub-regions (e.g., on either side of the arch).Alternatively or in addition, the dentition receiving cavity may includea gap or space where a tooth is missing; in some variations the body 202is configured to attach to just a portion of the patient's dental arch(e.g., the molar/pre-molar region, etc.). The dentition-receiving cavity204 may comprise a plurality of lateral wall surfaces 210 configured tobe placed in contact with surfaces of the patient's teeth when thedevice is worn over the dental arch. The dentition-receiving cavity 204in this example includes a first cut-out region 212 at a first terminalend of the arch and a second cut-out region at a second terminal end(e.g., posterior ends) of the arch. The first and second cut-out regionsare surrounded by lateral wall surfaces and expose the occlusal surfacesof the patient's molars when the device is worn over the dental arch.The occlusal window can extend over two or more teeth (e.g., all themolars) or three or more teeth. In some embodiments, a thickness of theocclusal surface sections is thinner near the first and second terminalends of the arch and becomes thicker towards the anterior region of thearch. The cut-out regions or windows can extend into the lateral wallsurfaces of the portion of the dentition-receiving cavity adjacent tothe patient's molars.

FIGS. 3A and 3B show additional embodiments of an aligner comprisingocclusal windows or cutouts. As shown in FIG. 3A, the cutouts includeinterproximal supports 318 between buccal and lingual surfaces. Thealigner 302 comprises occlusal windows 304 or cut-outs over the occlusalsurfaces of the back 4 teeth on each terminal end of the arch. In someembodiments, the occlusal window can be positioned over 1, 2, 3, 5, 6,or more teeth of the dental arch. The occlusal window can be positionedat a terminal end of the dental arch. In some embodiments, the occlusalwindow is spaced away from a terminal end of the dental arch. Thealigner can comprise 1, 2, 3, 4, or more occlusal windows positionedalong the aligner body.

In some cases, removal of too much of the occlusal portion can reducerigidity of the aligner. Thus, in some variations, only the cusp tips orocclusal portions may be removed, leaving the interproximal crosssupports 328 in place, as shown in FIG. 3B. Alternatively oradditionally, these cross supports may be reinforced.

An additional and/or alternative solution may include a barrier (barrierregion) in the anterior (and in some variations lateral) portion(s) ofthe aligner that provides a similar or decreased vertical dimension towhat the patient had prior to wearing the aligners, so that the tongueis able to form a similar or better anterior seal while the aligners arebeing worn. In this manner, the problem of the lisp is reduced oreliminated and patients may be more likely to wear the aligners duringthe day and during social settings.

In some embodiments, for small increases in vertical dimension, thefeature may not be needed, but for patients with shallow overbite, openbite, patients with Class II or Class III overjet, or patients withocclusal features in the aligner that prevent them from closing downinto maximum intercuspation, the need for an anterior seal becomesgreater.

The anterior seal can be facilitated by providing a barrier that helpsthe tongue reduce or prevent air leakage so that lisping during speechis reduced or eliminated. This barrier can comprise a protrusion thatspans in the mesial-distal direction along the arch, across severalteeth and positioned either on the buccal or lingual of the teeth,depending on the arch. This feature may also be used in the posteriorportion of the aligner for patients with lateral open bites, where airleakage during speech occurs in the lateral or posterior-lateral regionsof the arch. If the air leakage is occurring laterally (e.g., near thecanines and premolars), the desired outcome may be accomplished with abarrier which creates a lateral seal with the tongue.

FIGS. 4A-D illustrate an embodiment of an orthodontic appliance (in thisexample, an aligner) 400 comprising a barrier portion 402. As shown inthe top perspective view of FIG. 4A and the bottom view of FIG. 4B, thealigner comprises an occlusal portion 404 having a dentition-receivingcavity 406 extending laterally in an arch as shown by arrow 416. Theocclusal portion has a first vertical height 410, as shown in the frontview of FIG. 4C. The dentition-receiving cavity 404 is configured to fitover a dental arch of a patient. The dentition-receiving cavitycomprises an occlusal surface section 408 adapted to be positioned overan occlusal surface of the patient's teeth. The aligner 400 alsocomprises a barrier portion 402 extending laterally and adjacent to aregion of the occlusal portion 404. The barrier portion has a secondvertical height 412 that may be at approximately the same or greaterheight (e.g., 0.5 mm greater, 1 mm greater) than the first verticalheight 410. The barrier portion is laterally continuous to reduce orprevent air leakage there through, so that a patient's tongue may form aseal against the barrier portion when the patient is speaking whilewearing the device. FIG. 4D shows the aligner 400 fitting over apatient's dental arch 414. In any of these variations the height of thebarrier region may be approximately 1× or greater (e.g., 1.01×, 1.02×,1.03×, 1.04×, 1.05×, 1.1×, 1.15×, 1.2×, 1.25×, 1.3×, 1.35×, 1.4×, 1.45×,1.5×, etc. or greater) the height of the maximum vertical height of theappliance. The barrier region may have any lateral extent, and maytypically extend along the distal (anterior) region (e.g., adjacent tothe anterior teeth). For example, the barrier region may extend adjacentto the entire dental arch (e.g., adjacent to the incisors, from canineto canine, from premolar to premolar, from molar to molar, etc.).

A side benefit of the barrier feature is that orthodontic forces on theteeth which come from the tongue pushing out the teeth bucally/faciallymay be reduced. The barrier feature may employ the same principle as a“tongue crib” (see, e.g., FIG. 5) for tongue thrust correction; but,unlike a tongue crib 501 which is open and made of wire, the featureclaimed is continuous laterally to reduce or restrict the air flow, andallow seal to be made, which may be helpful for speech articulation. Ifmild air flow is desired for improved salivary circulation or improvedair circulation during breathing, perforations or other surfacealterations like channels or ridges may be added to the feature. Here,any perforations need to be small enough so as not to disrupt theprimary objective of creating an adequate barrier seal with the tongueduring speaking in order to avoid lisping.

The following figures depict various embodiments of appliances withbarrier features. Unless described otherwise, the appliances describedbelow may comprise occlusal portions and dentition-receiving cavities asdescribed with respect to FIGS. 4A-4D, above. Furthermore, a ‘frontportion’ of an occlusal portion with a dentition-receiving cavityfitting over the dental arch may refer to the area near the canines andincisors, but may refer to a smaller (e.g., not extending past theincisors) or greater (e.g., extending past the canines) region thanthat. The ‘front portion’ of an occlusal portion with adentition-receiving cavity fitting over the dental arch may refer to thearea near the front 2-4 teeth, 2-6 teeth, or 2-8 teeth.

FIG. 6 illustrates a bottom view of an embodiment of an upper alignercomprising a barrier feature 604 positioned proximate to a front portionof an occlusal portion 602 of the aligner. The barrier feature 604comprises a continuous ridge in the aligner for the purpose of creatingan anterior seal with the tongue in order to reduce or prevent airleakage during speaking.

FIG. 7 illustrates a side view cross-section of an embodiment of analigner comprising an upper aligner 702 and lower aligner 704, whereinthe upper aligner comprises a barrier portion 708 and being worn by apatient. The upper aligner is shown on a model of the upper jaw teeth720; the lower aligner is shown on a model of the lower jaw teeth 721.The barrier portion 708 is positioned proximate to a front portion ofthe upper occlusal portion. The barrier portion 708 comprises amesial-distal barrier, in this embodiment positioned lingual to thedentition, which creates a barrier with the lower anterior teeth so thatair leakage is reduced or eliminated when the patient speaks. FIG. 7depicts the tongue 706 encountering the barrier portion 708. While FIG.7 shows a lingual positioning for the barrier portion 708, buccalpositioning is also possible. As mentioned above, the lower jaw of thepatient may be able to reposition forward such that lower anterior teeth(with or without an orthodontic appliance) abut against a barrierportion located in the upper arch aligner in order to provide a sealingsurface for the patient's tongue during speaking. This is illustrated,for example, in FIGS. 17A and 17B. In this example, similar to thatshown in FIG. 7, an upper aligner 1702 includes a barrier portion 1708lingual to the upper anterior teeth and is shown on the upper jaw 1720.The lower jaw 1721 sliding forward into a forward-repositioned locationwhereby a reduced anterior gap is created between the upper barrier 1708and the lower teeth 1721.

FIG. 8 illustrates a side view cross-section of an embodiment of analigner comprising an upper aligner 802 and a lower aligner 804, thelower aligner 804 comprising a barrier portion 808. The upper aligner isshown on a model of the upper jaw teeth 820; the lower aligner is shownon a model of the lower jaw teeth 821. The barrier portion 808 ispositioned near a front portion of an occlusal portion of the loweraligner 804 (a proximate or adjacent to the portion covering the caninesand/or incisors). The barrier portion 808 comprises a mesial-distalbarrier along the arch positioned near or on the dentition, whichcreates a barrier with the upper anterior teeth so that air leakage isreduced or eliminated when the patient speaks. FIG. 8 shows the tongue806 encountering the barrier portion 808. The barrier portion 808 maytypically be positioned lingually in the upper arch, particularly forpatients with excessive overjet, but buccal positioning in the lowerarch is also contemplated as shown in FIG. 8. In some embodiments, alower barrier portion 808 may be useful if an upper barrier portion isless desirable (e.g., aesthetically undesirable).

FIG. 9 illustrates an embodiment of an upper aligner 902 comprising anupper barrier portion 908 and a lower aligner 904 comprising a lowerbarrier portion 910. The upper aligner is shown on a model of the upperjaw teeth 920; the lower aligner is shown on a model of the lower jawteeth 921. One barrier in each arch may be needed if the anteriorvertical dimension is excessive (in severe anterior open bite patients,for example) whereby the barrier height needed is greater than what ispractical or possible to manufacture into a single aligner. The barrierportions 908, 904 may be positioned towards a front portion of theirrespective occlusal portions. In some embodiments, one or both of thebarrier portions are positioned away from the front portion of theirrespective occlusal portions. Both of the barrier portions 908, 910 maybe positioned lingually. In some embodiments, one barrier portion can bepositioned lingually and the other buccally. In some embodiments, bothbarrier portions are positioned buccally, but for esthetic reasons,typically this configuration would more likely be used in the case ofpatients with lateral open bites. FIG. 9 shows the tongue 906encountering the barriers 908, 910.

In some embodiments, the barrier feature is lingually positioned on thelower arch of the aligner or buccally located on the upper arch of thealigner. Such embodiments may be appropriate for patients with Class 3bite relationships, in which the lower arch is forward of the upper jawposition in a negative overjet relationship. FIG. 10 depicts anembodiment of an upper aligner 1002 with an upper barrier portion 1008and a lower aligner 1004 with a lower barrier portion 1010. The barrierportions 1008, 1010 are positioned proximate or adjacent to a frontportion of their respective aligner's occlusal portion. The upperbarrier portion 1008 is positioned buccally, and the lower barrierportion 1010 is positioned lingually. This configuration may not beesthetically feasible in the upper arch, so having the feature presentonly in the lower arch may be required for Class 3 patients withsignificant negative overjet. The upper aligner is shown on a model ofthe upper jaw teeth 1020; the lower aligner is shown on a model of thelower jaw teeth 1021.

FIG. 11 shows an embodiment of an upper aligner 1102 and a lower aligner1104, the upper aligner 1102 comprising a barrier portion 1108. Thebarrier portion 1108 is positioned toward the front of an occlusalportion of the upper aligner 1102 and is positioned lingually or closerto the palatal region. Such an embodiment can be appropriate for Class 2patients with excessive overjet 1110, particularly if the patient'slower jaw is no longer growing or if the jaw is unable to repositionforward into a stable Class 1 bite relationship. The barrier portion maybe positioned closer to or even on the palatal region. FIG. 11 shows thetongue 1106 encountering the barrier portion 1108. The upper aligner isshown on a model of the upper jaw teeth 1120; the lower aligner is shownon a model of the lower jaw teeth 1121.

Some embodiments of aligners comprise aligner features which open thepatient's bite. In such embodiments, an anterior seal may become evenmore critical, because of the temporary anterior open bite intentionallycreated when the aligners are worn. FIGS. 12A and 12B depict embodimentsof an upper aligner 1202 having an upper barrier portion 1208, and inFIG. 12B and upper 1208 and a lower aligner 1204 having a lower barrierportion 1210. The aligners comprise bite repositioning features 1212(e.g., twin block features). FIG. 12A shows the tongue 1206 encounteringthe barrier portions 1208, 1210. The upper aligner is shown on a modelof the upper jaw teeth 1220; the lower aligner is shown on a model ofthe lower jaw teeth 1221.

As mentioned above, any of the apparatuses (e.g., appliances, includingbut not limited to aligners) described herein may include a barrierregion (or multiple barrier regions) that extend laterally along theside, e.g., adjacent to the premolars and/or molars. These apparatusesmay therefore prevent air leakage from the sides and/or allow sealing bythe tongue along these lateral side regions. In apparatuses, such as theexample shown in FIG. 12A-12B, that may induce or address a lateral openbite, a lateral lingual or buccal barrier may be include to reduce orprevent leakage. For example, in FIGS. 12C to 12E the barrier regionextend adjacent to the majority of the apparatus. For example, in FIG.12C the apparatus includes an upper appliance 1202 and a lower appliance1204 similar to those shown in FIG. 12A-12B. In FIG. 12C, the barrierportion 1208′ is not limited to the anterior portion, but extends longboth sides of the appliance (e.g., the upper and/or lower appliance).This may prevent air leakage from the sides of the appliance(s). Any ofthese apparatuses may be included along with an occlusal stop so thatthere is a resting position in which the appliance sits on the backteeth (e.g. molars).

In FIG. 12C, as shown in FIG. 12A-12B, the bite repositioning features1212 on the upper and lower appliances may limit the closure(intercuspation) of the teeth on the upper and lower arches; in any suchvariations in which the bite is modified, a barrier region may beincluded. FIG. 12D, for example, illustrates an example in which abarrier region 1208′ extends lateral from the right rear molar to theleft rear molar along the entire lingual side, and adjacent to the biterepositioners 1212, 1212′. The height of the barrier region is typicallythe same or larger than the maximum height of these bite repositioners;the height of the barrier region may vary along the length. The barrierregion may be positioned laterally on the lingual side (as shown inFIGS. 12D and 12E) or on the buccal side. The barrier may act as ashield, for example (e.g., a lingual shield), preventing the tongue frominteracting with the spacer(s) and/or the appliance. In FIG. 12E, thetop view shows the appliance in which the barrier region 1208′ isrecessed slightly lingually from the appliance.

Barrier portions can also be advantageous in embodiments of aligners1302 in which anterior bite ramps 1310 are used in the upper lingualarea, as shown in FIG. 13A. In such embodiments, the addition of abarrier can be desirable in order to form a seal with the tongue andreduce or prevent air leakage. Anterior bite ramps are often used whentreating patients with a deep bite and an accentuated curve of Spee, andthis curve often leads to a lateral opening prone to air leakage whenthe lower jaw is advanced forward. FIG. 13B illustrates embodiments ofan upper aligner 1302 and a lower aligner 1304. FIG. 13B shows a sideview of both aligners in the mouth (shown on a partial sectional view ofa patient's mouth or a model of a patient's upper and lower jaws, forsimplicity). In FIG. 13B, the barrier 1310 is in front of the bite ramp1308. The lower jaw 1321 may slide forward (anteriorly) and rest on theanterior vertical stops (bite ramps 1308) which may also contain abarrier portion to block air leakage. FIG. 13C shows a bottom view ofthe upper aligner 1302. The upper aligner 1302 comprises bite ramps 1310and a barrier potion 1308.

When implementing the treatments described herein, customized alignerscan be used. A simulation of an aligner including features can be placedover the thickness of the teeth. The simulated aligner can include anyfeatures used by the patient, such as bite ramps or bite repositioners.The effect of the aligner on the bite is observed in the simulation.Virtual, digital modeling can show the bite angle changes using, forexample, a virtual articulator, which can, in turn, show how much thebite opening changes the vertical dimension. Based on such a simulation,a barrier feature can be created to return the bite to a normal verticaldimension.

Generally, the goal is for the barrier portion to extend vertically andcreate an artificial overbite. In some embodiments, the barrier portionmay have to expand beyond the perimeter of the arch. The patient'sfacial shape may influence the configuration of the barrier portion. Jawangle can correspond to face shape. For example, a long facial profile(i.e., dolichofacial) can comprise a downward sloping angle in the lowerjaw, while a short, square face pattern (i.e., brachyfacial) cancomprise a more parallel angle between the lower and upper jaws. Inpatients with the long facial pattern, the downward sloping angle of themandible can exaggerate any opening caused by a thickness on theocclusal surfaces of the back teeth. In such cases, the barrier portioncan utilize a tapering height to avoid adding any thickness to thealigners in the posterior regions near the terminal ends. For example,the barrier extension can be 3 mm vertical in the front, but taper to 0mm in height closer towards the back teeth of the dental arch.

A patient may receive an orthodontic treatment course with a series ofaligners, for example 20-40 aligners. New sets of aligners can beprovided to the patient by the doctor every few weeks. Each aligner isconfigured to provide orthodontic forces which gradually move the teeth.The barrier portions may be provided in a first subset (e.g., the first5-10 aligners) of the series, and not be provided in the aligners to beused later.

The barrier portion can be manufactured as part of the aligner, similarto aligner ridges and bite ramps. Alternatively, the barrier portion canbe a piece that is manufactured separately (e.g. 3-D printed, milled, orinjection molded) and then connected to the aligner in a separatemanufacturing step (with adhesive, spot welding, ultrasonic welding,etc.). Alternatively, the barrier portion can be 3-D printed in adifferent material in the case of 3-D printed aligner appliances. Thisavoids needing a separate manufacturing step to connect the barrierportion to the aligner appliance.

When a barrier is included as part of aligner in a series of aligners,the position and/or size of the barrier may change within the series.For example, the initial aligners in the series may include a barrier(or a larger barrier); the barrier may be smaller, reducing in size, orabsent from subsequent aligners in the series.

The location and thickness of the barrier portion can be important. Thegreater the amount of surface area engagement of the aligner with theteeth, the more effective the tooth movement. Thus, it can beundesirable for the barrier portion to prevent or reduce the aligner'sinteraction with the teeth. A possible solution for this problem is toform the barrier portion as thinly as possible so that the base of thebarrier covers as much of the dentition as possible. To ensurestructural integrity of the barrier despite its thinness, the alignercan be fabricated from a refractory reference mold which containsstructural support tabs that break away from the mold when the aligneris separated from the mold during the fabrication process. In otherwords, the tabs built into the mold via 3-D printing, stereolithography,or milling, separate from the mold and become embedded inside thealigner barrier portion in order to confer extra structural support tothe aligner barrier feature. These embedded features are not limited toplastic materials, but can include metals, carbon fiber, and/orceramics, given that many different types of materials besides plasticcan now be 3-D printed as the refractory mold. Thus, in any of thedevices described herein, the barrier may include a reinforcing supportwithin the barrier, and this reinforcing support may be formed bysupport features that break away from the reference mold to becomeembedded inside the aligner barrier feature during the manufacturingprocess.

While many of the embodiments described herein have been applied tocases of anterior open bite, the same principles also apply to lateralopen bite. The barrier portions could be applied to posterior regions ofthe aligner in such cases, either unilaterally or bilaterally.Furthermore, in some embodiments, the aligner and barrier portions canbe used as standalone therapy for speech impediments, and not just fororthodontic treatments, as some patients may have trouble forming aproper seal with their mouth while speaking, even without an orthodonticappliance in place.

FIG. 14 shows an embodiment of a method of orthodontic treatment usingdevices such as those disclosed herein. As shown at block 1402, themethod comprises positioning an occlusal portion of an orthodonticdevice over the patient's dental arch so that the patient's teeth arewithin a dentition-receiving cavity of the occlusal portion. As shown atblock 1404, while the patient is wearing the orthodontic device, abarrier portion of the orthodontic device that is positioned adjacent toa region of the occlusal portion and extending vertically beyond theocclusal portion and away from the patient's teeth provides a sealingsurface for the patient's tongue during speaking.

FIG. 15 depicts another embodiment of a method of orthodontic treatmentusing devices such as those disclosed herein. As shown at block 1502,the method comprises positioning an occlusal portion of an orthodonticdevice over the patient's dental arch so that the patient's teeth arewithin a dentition-receiving cavity of the occlusal portion to applyforce to the patient's teeth to align the teeth by gradually moving thepatient's teeth relative to each other when the orthodontic device isworn. As shown at block 1504, while the patient is wearing theorthodontic device, a barrier portion of the orthodontic device that ispositioned adjacent to a region of the occlusal portion and extendingvertically beyond the occlusal portion and away from the patient's teethprovides a sealing surface for the patient's tongue during speaking.

Also described herein are methods of determining the dimensions of thebarrier portion included as part of an aligner apparatuses describedherein (or as part of an apparatus that is not configured to align theteeth). FIG. 16 is a schematic flow diagram illustrating a method ofdetermining the dimensions of a barrier in an aligner apparatus. Thismethod may be modified as necessary to determine the dimensions of abarrier for a device that is not also configured as an aligner, byomitting those steps not necessary to re-align the teeth. The models ofthe patient's dentition (including dimensions) may be made manuallyand/or electronically. For example, as shown in FIG. 16, the patient'sdentition may be initially scanned 1601 or otherwise determined (e.g.,using dental impressions, photographic or radiographic images, models,direct measurements, etc.). The patient's dentition may be scanned todetermine the patient's dentition and current bite relationship 1603, orthe bite relationship (e.g., between the teeth of the upper and lowerjaws) may be otherwise determined. Next, the position of desired biterelationship is determined (e.g., Class 1 molar and caninerelationship). This may be determined by scanning (e.g., the patient'smouth or a model of the dentition) the position of the desired biterelationship. For example, in a Class 2 patient, the lower jaw can beprotruded and the teeth scanned in the “protruded” Class 1 biterelationship. In another example, in a Class 3 patient, physical modelsof the arches can be repositioned into a Class 1 relationship and themodel relationship digitally captured. As an alternative to capturingaltered physical bite relationships, the target bite may also bedetermined by digitally manipulating a digital representation of thepatient's arches into the desired bite relationship. The goal in all ofthese manipulations is to create a model of the bite in a desired biterelationship 1607. Next, the teeth in the models of the arches may berepositioned to determine a desired relationship goal 1609. For example,the teeth may be digitally repositioned to determine a desired alignmentconfiguration. These steps (1607, 1609) may be repeated 1611 until adesired setup of bite relationship/teeth alignment combination isachieved.

The desired movements of the teeth and/or changes in the bite frominitial to goal may then be staged in discrete steps or stages, eachstep/stage representing an individual set of upper and lower aligners1613. Thereafter, the bite position can be adjusted (e.g., digitally)for each aligner stage to account for temporary vertical/sagittalchanges due to the repositioned teeth/bite, aligner thickness, biterepositioning aligner features, anterior bite ramp features, biteblocks, etc. 1615. Thereafter, aligner features (such as barriers orocclusal windows) may be added (e.g., digitally) at each stage toaccount for the temporary increase in the vertical dimension at eachstage due to the aligner thickness and/or additional aligner featurespresent 1617. Each aligner designed in this manner may then bemanufactured (e.g., as described herein) and provided to the patient fortreatment.

FIG. 18 is another example of an apparatus including a barrier portionextending laterally and adjacent to an occlusal portion. In this examplethe apparatus includes an upper appliance 1801 (upper arch appliance)and a lower appliance 1802 (lower arch appliance) that are configured tobe worn over the patient's upper and lower arch, respectively. The upperand lower appliances in this example are configured as a mandibularadvancement apparatus, in which each of the upper and lower appliancesinclude wings that may engage with each other to drive the lower jawforward during treatment when worn. For example, the upper archappliance 1801 includes a first upper precision wing 1805′ on a leftsides and a second upper precision wing 1805 on the right side. Thelower arch appliance may include a pair of wings (e.g., lower precisionwings 1803, 1803′) that may engage with each other to advance thepatient's mandible. In FIG. 18, the upper arch appliance also includes abarrier 1808 (barrier portion). Alternatively or additionally, the lowerarch appliance may include a barrier. In this example, the appliance(s)are formed as shell appliances that may also be configured to applyforce to move the teeth. In some variation, the appliances are notconfigured to move individual teeth, but may be configured formandibular advancement. When a patient is wearing the apparatus of FIG.18, the upper and lower appliances may be worn together, so that whenthe patient's mouth is closed, the upper appliance may engage with thelower appliance, driving the lower appliance forward to advance themandible; a seal may be formed between the patient's tongue and thebarrier 1808, as air may be prevented from passing through the region.As described above, this may enhance comfort and may also preventlisping or other speech difficulties.

In any of the appliance variations in which bite correction features areincluded (e.g., bite ramps, wings, etc.), the appliance(s) may includeany of the features described herein, such as barriers and/or thinned orremoved peak occlusal surface portions. In particular, any treatmentand/or apparatus that tends to open the bite may benefit from ananterior compensation for speech enhancement as described herein, inorder to avoid lisping in the patient. For example, appliances includinga bite ramp, and/or variable thickness appliance, such as aligners.

Another example of an apparatus that may be configured to enhance speech(e.g., preventing lisping, etc.) is shown in FIG. 19A. FIG. 19A showsone in a series of palatal expanders 1900 that may be worn by a subjectto expand the subject's palate (e.g., by widening the suture). Althoughany appropriate palatal expander may be used (includingadjustable/expandable variations) the apparatus shown in FIG. 19A may beworn as part of a series of palatal expanders worn sequentially toadjust the width of the palate.

FIG. 19B shows a variations of the palatal expander of FIG. 19A with abarrier region 1908 at the anterior (front) end of the apparatus. Ingeneral, the palatal expander includes an occlusal portion having adentition-receiving cavity 1907, 1907′ extending laterally in an archand having a first vertical height. In FIGS. 19A and 19B, the occlusalportion includes two dentition-receiving cavities, holding the molar andpremolars; a palatal region 1905 extends lateral to the occlusalportion, e.g., between the first and second dentition-receiving cavities1907, 1097′. Each dentition-receiving cavity is configured to fit over aportion of the patient's dental arch (e.g., the pre-molar and molars),and the dentition-receiving cavity may include an occlusal surfacesection adapted to be positioned over an occlusal surface of thepatient's teeth. In FIG. 19B, the apparatus includes a barrier region1908 that extends anteriorly from the palatal region on an extension orneck region 1911. The barrier portion therefore also extends laterallyand adjacent to the occlusal portion, as descried above. The barrierportion may have a vertical height that is approximately the same heightor a greater height than the maximum vertical height of the outerocclusal surface of the apparatus. As in any of these variations, thebarrier portion may be laterally continuous to reduce or prevent airleakage, so that a patient's tongue may form a seal against the barrierportion when the patient is speaking while wearing the device.

Any of these apparatuses described herein may be used when themolars/premolars have a reduced height. For example, in some patientshaving bruxism (e.g., due to grinding of teeth), wearing down of therear teeth, the jaw may overclose, resulting in a deep bite that mayalso lead to wear of the front teeth. Appliances to address this,including via restorative dentistry and/or the use of appliances (e.g.,a series of aligners) to adjust the teeth, including straightening them,prior to placing restorative crowns on the teeth. Any of theseappliances may include the structures, and particularly an anteriorbarrier structure, to enhance speech. Any of the methods, systems and/orcomponents described herein (including U.S. Pat. No. 8,936,463, showingaligners with images of the target alignment shown on them). The methodsand apparatuses described herein may prevent or limit leakage, includingbuccal leakage, through the apparatus.

When a feature or element is herein referred to as being “on” anotherfeature or element, it can be directly on the other feature or elementor intervening features and/or elements may also be present. Incontrast, when a feature or element is referred to as being “directlyon” another feature or element, there are no intervening features orelements present. It will also be understood that, when a feature orelement is referred to as being “connected”, “attached” or “coupled” toanother feature or element, it can be directly connected, attached orcoupled to the other feature or element or intervening features orelements may be present. In contrast, when a feature or element isreferred to as being “directly connected”, “directly attached” or“directly coupled” to another feature or element, there are nointervening features or elements present. Although described or shownwith respect to one embodiment, the features and elements so describedor shown can apply to other embodiments. It will also be appreciated bythose of skill in the art that references to a structure or feature thatis disposed “adjacent” another feature may have portions that overlap orunderlie the adjacent feature.

Terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.For example, as used herein, the singular forms “a”, “an” and “the” areintended to include the plural forms as well, unless the context clearlyindicates otherwise. It will be further understood that the terms“comprises” and/or “comprising,” when used in this specification,specify the presence of stated features, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, steps, operations, elements, components, and/orgroups thereof. As used herein, the term “and/or” includes any and allcombinations of one or more of the associated listed items and may beabbreviated as “/”.

Spatially relative terms, such as “under”, “below”, “lower”, “over”,“upper” and the like, may be used herein for ease of description todescribe one element or feature's relationship to another element(s) orfeature(s) as illustrated in the figures. It will be understood that thespatially relative terms are intended to encompass differentorientations of the device in use or operation in addition to theorientation depicted in the figures. For example, if a device in thefigures is inverted, elements described as “under” or “beneath” otherelements or features would then be oriented “over” the other elements orfeatures. Thus, the exemplary term “under” can encompass both anorientation of over and under. The device may be otherwise oriented(rotated 90 degrees or at other orientations) and the spatially relativedescriptors used herein interpreted accordingly. Similarly, the terms“upwardly”, “downwardly”, “vertical”, “horizontal” and the like are usedherein for the purpose of explanation only unless specifically indicatedotherwise.

Although the terms “first” and “second” may be used herein to describevarious features/elements (including steps), these features/elementsshould not be limited by these terms, unless the context indicatesotherwise. These terms may be used to distinguish one feature/elementfrom another feature/element. Thus, a first feature/element discussedbelow could be termed a second feature/element, and similarly, a secondfeature/element discussed below could be termed a first feature/elementwithout departing from the teachings of the present invention.

Throughout this specification and the claims which follow, unless thecontext requires otherwise, the word “comprise”, and variations such as“comprises” and “comprising” means various components can be co-jointlyemployed in the methods and articles (e.g., compositions and apparatusesincluding device and methods). For example, the term “comprising” willbe understood to imply the inclusion of any stated elements or steps butnot the exclusion of any other elements or steps.

In general, any of the apparatuses and methods described herein shouldbe understood to be inclusive, but all or a sub-set of the componentsand/or steps may alternatively be exclusive, and may be expressed as“consisting of” or alternatively “consisting essentially of” the variouscomponents, steps, sub-components or sub-steps.

As used herein in the specification and claims, including as used in theexamples and unless otherwise expressly specified, all numbers may beread as if prefaced by the word “about” or “approximately,” even if theterm does not expressly appear. The phrase “about” or “approximately”may be used when describing magnitude and/or position to indicate thatthe value and/or position described is within a reasonable expectedrange of values and/or positions. For example, a numeric value may havea value that is +/−0.1% of the stated value (or range of values), +/−1%of the stated value (or range of values), +/−2% of the stated value (orrange of values), +/−5% of the stated value (or range of values), +/−10%of the stated value (or range of values), etc. Any numerical valuesgiven herein should also be understood to include about or approximatelythat value, unless the context indicates otherwise. For example, if thevalue “10” is disclosed, then “about 10” is also disclosed. Anynumerical range recited herein is intended to include all sub-rangessubsumed therein. It is also understood that when a value is disclosedthat “less than or equal to” the value, “greater than or equal to thevalue” and possible ranges between values are also disclosed, asappropriately understood by the skilled artisan. For example, if thevalue “X” is disclosed the “less than or equal to X” as well as “greaterthan or equal to X” (e.g., where X is a numerical value) is alsodisclosed. It is also understood that the throughout the application,data is provided in a number of different formats, and that this data,represents endpoints and starting points, and ranges for any combinationof the data points. For example, if a particular data point “10” and aparticular data point “15” are disclosed, it is understood that greaterthan, greater than or equal to, less than, less than or equal to, andequal to 10 and 15 are considered disclosed as well as between 10 and15. It is also understood that each unit between two particular unitsare also disclosed. For example, if 10 and 15 are disclosed, then 11,12, 13, and 14 are also disclosed.

Although various illustrative embodiments are described above, any of anumber of changes may be made to various embodiments without departingfrom the scope of the invention as described by the claims. For example,the order in which various described method steps are performed mayoften be changed in alternative embodiments, and in other alternativeembodiments one or more method steps may be skipped altogether. Optionalfeatures of various device and system embodiments may be included insome embodiments and not in others. Therefore, the foregoing descriptionis provided primarily for exemplary purposes and should not beinterpreted to limit the scope of the invention as it is set forth inthe claims.

The examples and illustrations included herein show, by way ofillustration and not of limitation, specific embodiments in which thesubject matter may be practiced. As mentioned, other embodiments may beutilized and derived there from, such that structural and logicalsubstitutions and changes may be made without departing from the scopeof this disclosure. Such embodiments of the inventive subject matter maybe referred to herein individually or collectively by the term“invention” merely for convenience and without intending to voluntarilylimit the scope of this application to any single invention or inventiveconcept, if more than one is, in fact, disclosed. Thus, althoughspecific embodiments have been illustrated and described herein, anyarrangement calculated to achieve the same purpose may be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments.Combinations of the above embodiments, and other embodiments notspecifically described herein, will be apparent to those of skill in theart upon reviewing the above description.

What is claimed is:
 1. An orthodontic device that prevents lisping, thedevice comprising: an occlusal portion having a dentition-receivingcavity extending laterally in an arch and having a first verticalheight, wherein the dentition-receiving cavity is configured to fit overa dental arch of a patient, the dentition-receiving cavity comprising anocclusal surface section adapted to be positioned over an occlusalsurface of the patient's teeth; and a barrier portion extendinglaterally and adjacent to the occlusal portion, the barrier portionhaving a second vertical height that is approximately the same height ora greater height than the first vertical height, wherein the barrierportion is laterally continuous to reduce or prevent air leakage, sothat a patient's tongue may form a seal against the barrier portion whenthe patient is speaking while wearing the device.
 2. The device of claim1, wherein the barrier portion is positioned on a lingual side of theocclusal portion.
 3. The device of claim 1, wherein the barrier portioncomprises a ridge.
 4. The device of claim 1, wherein the barrier portioncomprises micro-perforations to allow local circulation of saliva orair.
 5. The device of claim 1, wherein the second vertical height of thebarrier portion is more than about 1 mm higher than the first verticalheight of the occlusal portion.
 6. The device of claim 1, wherein thesecond vertical height of the barrier portion is between about 2-4 mmhigher than the first vertical height of the occlusal portion.
 7. Thedevice of claim 1, wherein the barrier portion is positioned on a buccalside of the occlusal portion.
 8. The device of claim 1, furthercomprising one or more wings extending from the device adjacent to theocclusal portion configured to engage with one or more wings extendingfrom a second device worn on an opposite arch.
 9. The device of claim 1,further comprising a palatal region extending from the occlusal portionthat is configured to be positioned adjacent to the patient's palatewhen the patient is wearing the device.
 10. The device of claim 1,further comprising one or more bite ramps on the occlusal portion. 11.The device of claim 1, wherein the dentition-receiving cavity isconfigured to fit over an upper dental arch of the patient.
 12. Thedevice of claim 1, wherein the dentition-receiving cavity is configuredto fit over a lower dental arch of the patient.
 13. The device of claim1, wherein the barrier portion is formed integrally with the occlusalportion.
 14. The device of claim 1, wherein the barrier portion isformed separately from and is attached to the occlusal portion.
 15. Thedevice of claim 1, wherein the barrier portion is positioned lingual tothe occlusal portion adjacent to a portion of the barrier portion thatfits over a patient's incisors when the device is worn by the patient.16. The device of claim 1, wherein the barrier portion is positionedadjacent to a portion of the barrier portion that fits over a patient'sincisors and canines when the device is worn by the patient.
 17. Thedevice of claim 1, wherein the barrier portion is tapered.
 18. Thedevice of claim 1, wherein the barrier portion comprises a reinforcingsupport within the barrier portion.
 19. An orthodontic aligner devicethat prevents lisping, the device comprising: an aligner body having adentition-receiving cavity extending laterally in an arch and having afirst vertical height, wherein the dentition-receiving cavity isconfigured to fit over at least a portion of a dental arch of a patient,the aligner body further configured to apply a force to a first set ofteeth in the dentition-receiving cavity, the dentition-receiving cavitycomprising a plurality of upper surface sections configured to bepositioned over occlusal surfaces of the patient's teeth when the deviceis worn over the dental arch of the patient, and a plurality of lateralwall surfaces configured to be placed in contact with sides of thepatient's teeth when the device is worn over the dental arch, furthercomprising a first cut-out region at a first terminal end of the archand a second cut-out region at a second terminal end of the arch,wherein the first cut-out region and the second cut-out regions aresurrounded by lateral wall surfaces and expose the occlusal surfaces ofthe patient's rear teeth when the device is worn over the dental arch.20. The device of claim 19, wherein the cut-out region extends over twoor more teeth when the device is worn over the patient's dental arch.21. The device of claim 19, wherein the cut-out region extends overthree or more teeth when the device is worn over the patient's dentalarch.
 22. The device of claim 19, wherein a thickness of the uppersurface sections is thinner near the first and second terminal ends ofthe arch, and gets thicker towards a middle region between the first andsecond terminal ends of the arch.
 23. The device of claim 19, whereinthe cut-out regions extend into the lateral wall surfaces of the portionof the dentition-receiving cavity adjacent to the patient's molars whenthe device is worn over the dental arch.
 24. The device of claim 19,further comprising a barrier portion extending laterally adjacent to thealigner body, the barrier portion having a barrier vertical height thatis greater than a first vertical height of the aligner body, wherein thebarrier portion is laterally continuous to reduce or prevent airleakage, so that a patient's tongue may form a seal against the barrierportion when the patient is speaking while wearing the device.
 25. Thedevice of claim 19, further comprising a plurality of interproximalsupports between buccal and lingual surfaces of the lateral wallsurfaces.
 26. A method of orthodontic treatment of a patient thatprevents lisping, the method comprising: positioning an occlusal portionof an orthodontic device over the patient's dental arch so that at leasta portion of the patient's teeth are within a dentition-receiving cavityof the occlusal portion, wherein, while the patient is wearing theorthodontic device, a barrier portion of the orthodontic device that ispositioned adjacent to the occlusal portion and extending verticallybeyond the occlusal portion and away from the patient's teeth provides asealing surface for the patient's tongue during speaking.
 27. The methodof claim 26, wherein the barrier portion extends laterally adjacent tothe patient's incisors when the patient is wearing the orthodonticdevice.
 28. The method of claim 26, wherein the barrier portion extendsin a continuous lateral surface adjacent to the patient's incisors whenthe patient is wearing the orthodontic device to reduce or prevent airleakage therethrough.
 29. The method of claim 26, further comprisingdifferentially applying force to the patient's teeth to gradually movethe patient's teeth relative to each other when the orthodontic deviceis worn.
 30. The method of claim 26, further comprising positioning asecond occlusal portion of a second orthodontic device over a seconddental arch of the patient so that the patient's teeth in the seconddental arch are within a second dentition-receiving cavity of the secondocclusal portion.
 31. The method of claim 26, further comprisingpositioning a second occlusal portion of a second orthodontic deviceover a second dental arch of the patient so that the patient's teeth inthe second dental arch are within a second dentition-receiving cavity ofthe second occlusal portion and providing a second barrier portion ofthe second orthodontic device that is positioned adjacent to a secondregion of the second occlusal portion to provide a second sealingsurface for the patient's tongue during speaking.